Marmar C. R., Weiss D., Gaston L. (1989b). Towards the validation of the California therapeutic alliance rating system. Psychol. Assess. 1, 46–52 10.1037/1040-3590.1.1.46 [ CrossRef] [ Google Scholar] An example of this could be the way in which a client views their therapist, whether that is as a stern father figure or a mother who withholds attention. These dynamics and interactions matter and how they play out within the therapeutic bond can allow a client to gain a deeper understanding of their relationships. Again, we see here how important the role of the therapist is in giving a client an opportunity to explore their external world within the therapeutic space. Strupp H. H., Hadley S. W. (1979). Specific versus non specific factors in psychotherapy: a controlled study of outcome. Arch. Gen. Psychiatry 36, 1125–1136 [ PubMed] [ Google Scholar] Recognition of the fact that different types of psychotherapy often reveal similar results gave rise to the hypotheses regarding the existence of variables common to all forms of therapy, rekindling interest in the alliance as a non-specific variable. Luborsky ( 1976) proposes a theoretical development of the concept of alliance, suggesting that the variations in the different phases of therapy could be accounted for by virtue of the dynamic nature of the alliance. He distinguished two types of alliance: the first, found in the early phases of therapy, was based on the patient’s perception of the therapist as supportive, and a second type, more typical of later phases in the therapy, represented the collaborative relationship between patient and therapist to overcome the patient’s problems – a sharing of responsibility in working to achieve the goals of the therapy and a sense of communion.

Genuineness -it is crucial that the therapist be a ‘real’ human being, meaning that they are able to freely and deeply be themselves, not an all-knowing expert. They must be a real person who can relate to one another genuinely. Bowlby J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Routledge and Kegan Paul [ Google Scholar] In the initial stage, the patient and therapist make an agreement to devote time and energy to achieve specific goals. In this stage, the perception of the therapist, intensity of client motivation, and compatibility of personality/experiences are important factors.The Preventing Mental Health Relapse worksheet is a wonderful tool to implement in the termination stage of treatment. This worksheet highlights warning signs and triggers the client should be aware of as they leave treatment. It is also a great way for the client to take ownership of the work they have done in therapy and their future mental health. The bond between the therapist and client is formed from trust and confidence that the selected tasks will move the client toward their goals. In our opinion, regarding the relationship between the therapeutic alliance and the outcome of psychotherapy, future research should pay special attention to the comparison between patients’ and therapists’ assessments of the therapeutic alliance: these have often been found to differ, and evidence suggests that the patient’s assessment is a better predictor of the outcome of psychotherapy (Castonguay et al., 2006). In Horvath’s ( 2000) opinion, this might be explained by the limitations of assessment procedures, since the rating scales are usually validated on the basis of patient data, whereas the therapist views the relationship through a “theoretical lens,” thus tending to assess the relationship according to what the theory suggests is a good therapeutic relationship or according to the assumptions about the signs that indicate the presence or absence of the desirable relationship qualities. On the other hand, the patients’ assessments tend to be more subjective, atheoretical, and based on their own past experiences in similar situations. This accounts for the difficulties associated with the concept of alliance, which is built interactively, and so any assessment must also consider the mutual influence of the participants. In a helpful contribution, Hentschel ( 2005) points out that the problematic aspect of empirical studies investigating the alliance is their tendency to view the alliance construct as a treatment strategy and a predictor of therapeutic outcome: if the therapist is instructed, for instance, on methods of increasing the level of alliance, and is then asked to rate the alliance, this can lead to a contamination of the results. The use of neutral observers or the creation of counterintuitive studies is therefore recommended. It is the collaborative relationship between these two parties engaged in the common fight to overcome the patient’s suffering and self-destructive thoughts and behaviors, and effect beneficial change. These scales have been shown to be moderately correlate with outcome ( r=0.24; Martin et al., 2000).

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A good relationship, the research finds, is essential to helping the client connect with, remain in and get the most from therapy. “It’s primary in the sense of being the horse that comes before the carriage, with the carriage being the interventions,” says Simon Fraser University emeritus professor Adam O. Horvath, PhD, who studies the therapy alliance. Orlinsky D. E., Howard K. I. (1986). “Process and outcome in psychotherapy,” in Handbook of Psychotherapy and Behaviour Change: An Empirical Analysis, 3rd Edn, eds Garfield S. L., Bergin A. E. (New York: Wiley; ), 311–385 [ Google Scholar]

Do they even have life preservers (tools for depression reduction) in the office? Or are their techniques irrelevant to depression treatment? Bordin E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy (Chic.) 16, 252–260 [ Google Scholar]

Di Nuovo S., Lo Verso G., Di Blasi M., Giannone F. (1998). Valutare le psicoterapie: La ricerca italiana. Milano: Franco Angeli [ Google Scholar] Greenson R. R. (1965). The working alliance and the transference neurosis. Psychoanal. Q. 34, 155–179 [ PubMed] [ Google Scholar] The KAS was developed to rate the quality of the therapeutic alliance from the patient’s perspective. The scale comprises the three dimension of the alliance originally proposed by Bordin ( 1979) plus a fourth dimension: the patient’s empowerment, i.e., the patient becoming more responsible for his/her own care and more involved in making choices.